1661 Colo-Colic Intussusception Secondary to a Large Submucosal Colonic Lipoma

Abstract

INTRODUCTION: Intussusception is telescoping of a proximal segment of bowel into the lumen of the adjacent distal segment of bowel. This condition is usually seen in the pediatric population and is most often due to a benign pathologic lead point. Intussusception remains a rare condition in adults, representing approximately 1–5% of mechanical bowel obstructions typically due to malignancy. We present a rare case of Colo-colic intussusception secondary to a sub-mucosal benign lipoma. CASE DESCRIPTION/METHODS: A 33-year-old Caucasian woman with no past medical or surgical history, presented with one month of intermittent left-sided and mid-abdominal cramping, which intensified the week prior to presentation. She reported increasing post-prandial pain with associated nausea and bloating. Physical exam revealed stable hemodynamics, and diffuse abdominal tenderness to palpation. Laboratory testing was unremarkable, including a serum pregnancy test. Contrasted CT Abdomen/Pelvis revealed intussusception of the mesenteric tissues and transverse colon into the descending colon with a discrete mass lesion as the lead point (Figure 1). A colonoscopy revealed a large, non-obstructing, hard, negative pillow sign, subepithelial mass, with a short stalk at the hepatic flexure was encountered (Figure 2). The patient underwent laparotomy by colorectal surgeon. A proximal transverse colon intussusception was identified and a right hemicolectomy with ileocolonic anastomosis was completed. Surgical pathology results revealed a 6.5 cm submucosal lipoma without evidence of dysplasia or malignancy (Figure 3). The patient recovered well post-operatively and was discharged. DISCUSSION: In adults, the diagnosis of intussusception can be difficult to make based on clinical presentation alone due to the rarity and non-specific complaints. The condition is commonly related to malignancy. Generally, colo-colic intussusceptions are the least common. Cross sectional imaging, such as CT scans with IV contrast are the most sensitive diagnostic tests. Our case identifies an uncommon cause of abdominal pain in an adult patient with the CT scan and diagnostic laparotomy revealing a colo-colic intussusception. In this fortunate case, pathology revealed a benign lesion as the lead point. Although colonic lipomas are common this patient has low risk factors such as age and no metabolic syndrome, they are often asymptomatic and have been rarely reported to cause similar presentations as they increase in size ( >4 cm).